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Comparative Study
. 2011 Jul;140(1):54-61.
doi: 10.1378/chest.10-1082. Epub 2011 Mar 10.

Differences in breathing patterning during wakefulness in patients with mixed apnea-dominant vs obstructive-dominant sleep apnea

Motoo Yamauchi  1 , Shinji Tamaki  2 , Masanori Yoshikawa  2 , Yoshinobu Ohnishi  3 , Hiroshi Nakano  4 , Frank J Jacono  5 , Kenneth A Loparo  6 , Kingman P Strohl  5 , Hiroshi Kimura  2
Affiliations
Comparative Study

Differences in breathing patterning during wakefulness in patients with mixed apnea-dominant vs obstructive-dominant sleep apnea

Motoo Yamauchi et al. Chest. 2011 Jul.

Abstract

Background: Mixed apneas share both central and obstructive components and are often treated as if they are obstructive events. The hypothesis is that patients with obstructive sleep apnea syndrome (OSAS) who exhibit a majority of mixed apneas will differ in ventilatory control from those with predominantly obstructive apneas during wakefulness; moreover, this difference could affect nasal continuous positive airway pressure (CPAP) adherence.

Methods: In a retrospectively derived case-control study, 5 min of respiratory inductance plethysmography signals during wakefulness prior to sleep onset were extracted from a diagnostic polysomnogram in these groups: (1) mixed apnea-dominant OSAS (mix-OSAS) (n = 36), (2) obstructive apnea-dominant OSAS (pure-OSAS) (n = 20), (3) central apnea-dominant sleep apnea syndrome (pure-CSAS) (n = 6), and (4) control subjects (n = 10). Breathing patterning was compared between the groups using the coefficient of variation (CV) for breath-to-breath inspiration time (TI), expiration time (TE), TI + TE (Ttot), and tidal volume, and an information theory-based metric of signal pattern variability (sample entropy). Subsequent CPAP adherence over 12 months was determined in OSAS groups.

Results: Breath-to-breath CV parameters and sample entropy in the mix-OSAS group were significantly greater as compared with the pure-OSAS and control groups. In a subanalysis, CV and sample entropy were similar in the mix-OSAS and the pure-CSAS groups. CPAP adherence was significantly poorer in mix-OSAS compared with pure-OSAS.

Conclusions: During wakefulness, both breath patterning and sample entropy in mix-OSAS are similar to pure-CSAS and more variable than in pure-OSAS. In addition, CPAP adherence was decreased in patients with mix-OSAS, which may be related to basic differences in respiratory control.

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Figures

Figure 1.
Figure 1.
Respiratory inductance plethysmography (RIP)-sum tracings prior to sleep onset in two patients with mix-OSAS and two patients with pure-OSAS. Respiratory patterns are more irregular in mix-OSAS as compared with pure-OSAS. mix-OSAS = mixed apnea-dominant obstructive sleep apnea syndrome; pure-OSAS = obstructive apnea-dominant obstructive sleep apnea syndrome.
Figure 2.
Figure 2.
Coefficients of variation (CV) for breath-to-breath respiratory variables during resting breathing before sleep onset. Values are mean ± SD. A, Ti. B, Te. C, Ttot. D, Tidal volume. Resting breathing during wakefulness was more irregular in patients with mix-OSAS than in those with pure-OSAS and control subjects as expressed by higher CV values in all respiratory variables. Te = expiration time; Ti = inspiration time; Ttot = Ti1Te. See Figure 1 legend for expansion of other abbreviations.
Figure 3.
Figure 3.
Sample entropy values for original data set (black bar) and surrogate data set (gray bar). Values are mean±SD. See Figure 1 legend for expansion of abbreviations.
See this image and copyright information in PMC

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